Spondylolysis and Spondylolisthesis

Your spine, or backbone, is the primary source of support for your skeleton. The spinal column is made up of small bones called vertebrae. Vertebrae have a thick, chunky body connected to a ring-shaped hind portion. They are stacked on top of each other with cushioning discs (fluid-filled sacs) between them.

Spondylolysis occurs when part of the vertebra, called the pars, is broken. Without the pars, the spinal nerves are exposed and the vertebra is disconnected from the spine. Spondylolisthesis occurs when one vertebra slips forward onto another, which is often the result of spondylolysis. When the supporting pedicle is broken, the joint cannot hold the vertebra in place.

Spondylolysis and spondylolisthesis usually occur in the last vertebra in the lumbar region, which is located in the lower back.

Causes
Spondylolysis and spondylolisthesis usually develop in adolescence, when growing bones are at risk for a stress fracture.

Symptoms
Most people have no symptoms. Patients typically become aware of their condition with the development of low back or leg pain. Spasms may occur in the back muscles, and you may have numbness or weakness in one or both legs. Posture and gait may also be affected due to muscle tightness.

Diagnosis
Your doctor will discuss your symptoms and the history of your condition. A physical examination will be completed, including touching the back to locate areas of tenderness. The diagnosis may be confirmed by viewing the spine and surrounding tissues with X-rays, MRI (magnetic resonance imaging), or a CT (computed tomography) scan.

Treatment
Treatment for spondylolysis and spondylolisthesis depends upon your age, sex and the severity of your condition. Conservative treatment may include the following:

• rest, to allow the area to heal
• medications such as muscle relaxants to control muscle spasms, and anti-inflammatories to reduce swelling and pain
• changes in activity to prevent irritation of the area
• back brace for support
• exercise to stretch and strengthen the back and trunk
• physical and/or occupational therapy for specialized treatments and individualized rehabilitation programs.

In some cases, surgical treatment is needed. An orthopaedic surgeon will complete the procedure to remove bone and tissue that is pressing on the nerves. Additionally, a spinal fusion may be performed to stabilize the area.

Outlook
Spondylolysis and spondylolisthesis are chronic conditions, with symptoms usually changing, coming and going for years. Conservative treatment usually offers relief in a few weeks. For patients requiring surgery, full recovery may take six months to one year for the area to heal. It is important to follow the instructions of your doctor and therapist to ensure your rehabilitation.